Date Reported

Status

Provider Type(s) Impacted

Part A, including HHH and FQHCs

Date Resolved

4/6/20

Reason Code(s)

Part A RCs, see below

Claim Coding Impact

Multiple ICD-10 codes to be added to the listed NCDs

Description of Issue

On 11/1/2019, CMS issued CR11491 and accompanying MLN11491 with an effective date of 4/1/2020. CMS has now issued additional instructions impacting the following NCDs, for which new ICD-10 diagnosis codes will not be systematically implemented until 4/6/2020.

Local editing will be temporarily implemented for the following, allowing claims to process:

NCD 20.9 Artificial Hearts and Related Devices – RC 59242-59243

NCD 20.34 Percutaneous Left-Atrial Appendage Closure – RC 59267

NCD 190.11 Home PT/INR – RC 59079-59080

NCD 260.9 Heart Transplants – RC 59180-59181

Editing will remain in place for the following, and denied claims subject to the standard appeal process:

NCD 110.4 Extracorporeal Photophoresis RC59019-59020, 59023-59024

NCD 210.3 Colorectal Cancer Screening RC 59099-59100

National Government Services Action

For NCDs 20.9, 20.34, 190.11 and 260.9, National Government Services (NGS) will now modify internal editing to allow processing for claims with the new ICD-10 diagnosis codes. For NCDs 110.4 and 210.3, denials relative new ICD-10 codes may be submitted as appeals. In addition, NGS will adjust claims already denied since 10/1/2019 relative to this issue when brought to our attention.

Date Reported

Status

Provider Type(s) Impacted

Date Resolved

Reason Code(s)

Claim Coding Impact

Description of Issue

National Government Services is advising hospice providers of two recently identified issues that are impacting payments on hospice adjustments.

The issues are as follows:

Hospice EOLSIA Payment

Starting in January 2020, Medicare systems stopped applying the EOL SIA payment on adjustments to hospice claims with eligible services that occurred the month prior and within seven days of the beneficiary’s date of death. The system was updated and claims are adjustments are calculating the EOL SIA payment correctly as of 4/20/2020.

Hospice Adjustments Overpaying RHC days

Adjustments to hospice claims with routine home care days billed are paying the wrong routine home care rate. The CWF edit is not applying the prior days used correctly causing claims reimburse incorrectly pay at the high or low rate.

National Government Services Action

NGS will continue to follow the situation with the Medicare system maintainers and advise providers of any changes in this information or further updates.

Provider Action

At this time, no workaround has been identified to prevent improper payments for routine home care service on hospice adjustments. Providers are advised to consider holding adjustments to claims with routine home care days when the prior days used are greater than 60. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information.

Proposed Resolution/Fix

Updated 5/1/2020

Some Accelerated Payments Showing Incorrect Positive Value

Date Reported

4/22/20

Status

Closed

Provider Type(s) Impacted

J6 and JK Providers

Date Resolved

4/26/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

Some X12 835 ERA files are showing accelerated payments as positive values in the PLB segment (provider adjustment). The accelerated payments should be showing as a negative value which increases the payment to the provider in the remittance file only.

National Government Services Action

4/22/2020: Listserv was sent to J6 and JK provider community to alert them of positive accelerated payment amounts that are not impacting actual payments. National Government Services is actively working on a fix.

4/26/2020: NGS implemented a fix and the issue is now resolved. Accelerated payments will now show as a negative value on any X12 835 ERA files delivered 4/27/2020 and after.

Provider Action

No action is required. This issue has been resolved.

Proposed Resolution/Fix

Implementation date: 4/26/2020

Part A California Duplicate ERAs Delivered

Date Reported

4/10/20

Status

Closed

Provider Type(s) Impacted

J6 Part A California 06014 providers

Date Resolved

4/10/20

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

National Government Services Action

4/9/2020: Around 4:30 p.m. eastern time, NGS delivered duplicate 835 remittance advice files to the California Trading Partners/providers.
4/10/2020: Listserv was sent to the Part A and HH+H provider community to alert them of the duplicate files.

Please note: These files are duplicates of the 835 remittance advice files delivered on 4/4/2020. The 835 remittance advice files delivered on 4/9/2020 in the early morning hours are not duplicates. The duplicate files impact only the California files.

Provider Action

No provider action necessary.

Proposed Resolution/Fix

4/10/2020

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.

Date Reported

10/22/19

Status

Closed

Provider Type(s) Impacted

Ambulance providers that bill to Part B of A

Date Resolved

10/24/19

Reason Code(s)

N/A

Claim Coding Impact

An error in Part A skilled nursing facility (SNF) consolidated billing (CB) edit logic is causing incorrect denials for Part B ambulance claims.

Description of Issue

Part B ambulance claims submitted for emergency ambulance transport services for beneficiaries in SNFs are incorrectly denying due to an error in the Part A SNF CB edit logic. This error is impacting Part B claims for beneficiaries in covered Part A SNF stays when Part B claims are submitted for emergency ambulance transport. Impacted Part B claims included HCPCS codes: A0427, A0429 or A0433, billed with or without A0425.

National Government Services Action

As per a CMS directive, NGS is manually bypassing the SNF CB edit for incoming Part B emergency ambulance transportation claim lines containing HCPCS code A0427, A0429, A0433, billed with or without A0425, when the beneficiary is in a SNF Part A covered stay.

Provider Action

Update 11/14/2019: Part B Providers who identify claims denied in error may request written reopening to have the claim reprocessed. Use the In
Writing instructions on the Appeals page of our website to ensure your request is processed accurately. Please continue to check the Production Alerts section of our website and future Email Updates for additional status information.